How to

Become a SAMLA Medical Mediator

Medico-Legal Mediator (MLM)

SAMLA offers its members the exclusive opportunity to become a SAMLA Medico-Legal Mediator (MLM)

To join this distinguished register, members must meet specific requirements, complete the application form, and submit the necessary documents for approval.

Once approved, your details, field of specialisation, and email address will be included in the respective register, accessible on the SAMLA website.”

Please download all relevant documentation.

I, (full name) hereby apply to have my name included on the SAMLA Register of Medico-Legal Practitioners.

Title

Profession

ID Number

Office telephone No

Mobile phone No

Email address

Language proficiencies

Physical address of office or practice

Name/s of Professional Registration Authority or Authorities with which I am registered

Proof of certification by a relevant mediator training institution.

Signed copy of SAMLA Code of Conduct.

Curriculum Vitae, with ID and recent photograph.

AUTHORIZATION

In accordance with the POPI Act, I hereby authorize SAMLA to provide copies of the above documentation, which contains my personal information, to parties or clients who wish to appoint a Medico-Legal Mediator.

AFFIRMATION

By signing this application I affirm that I am in good standing with the Professional Registration Authority or Authorities indicated above; that I am a member in good standing of SAMLA; that I have read and accept the provisions of the SAMLA MOI; and that I have read and understood the SAMLA Code of Conduct.

PLEDGE

By signing this application I pledge to act in accordance with the ethical standards of the SAMLA Code of Conduct.

Date

SAMLA
South African
Medico-Legal Association

SAMLA
South African
Medico-Legal Association

How to

Become a SAMLA Medical Mediator

Medico-Legal Mediator (MLM)

Please download all relevant documentation.

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